Heterotopic Ossification Excision Improves Kinetic and Kinematic Gait Parameters as Demonstrated by Computerized Motion Analysis

Abstract

Heterotopic ossification (HO) is defined as formation of bone in abnormal locations. HO has been extensively reported in the orthopaedic literature, particularly following total hip arthroplasty, the operative treatment of acetabular fractures, and after spinal cord, traumatic brain, and burn injuries1-24. The hip is the most common site of HO. While many patients with HO are asymptomatic, more severe cases can result in pain and substantial limitations in joint range of motion. The Brooker classification, which is based on the appearance of HO on a single anteroposterior radiograph, remains the most commonly used classification system for HO, although other modified rating systems have been suggested3,7,25. In patients who undergo procedures that result in substantial risk of HO, prophylaxis can be considered; numerous studies have reported successful prophylaxis against HO formation in patients following total hip arthroplasty and open reduction and internal fixation for acetabular fractures2,9,15,16,20,21,24,26-30. The key to preventing HO is early prophylaxis in the inflammatory stage. In patients with symptomatic HO, surgical excision may be considered. Previous studies report improved range of motion following HO excision31-35. Because the incidence of HO recurrence after surgical excision is extremely high, postoperative prophylaxis with radiation or anti-inflammatory medications is recommended. To the best of our knowledge, this is the first case report of HO excision with documentation of both static and dynamic changes of hip range of motion with use of preoperative and postoperative three-dimensional (3D) computerized motion analysis. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. An eight-year-old girl with duodenal atresia had developed duodenal perforation …